两种麻醉方法在非体外循环冠脉搭桥手术中的应用比较  

Two anesthetic techniques in the off-pump coronary artery bypass grafting surgery

作　　者：王东春[1] 李丹 张树凡[3] 董英伟[1] 

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,黑龙江哈尔滨150001 [2]齐齐哈尔市中医院麻醉科 [3]齐齐哈尔市第一医院麻醉科,黑龙江齐齐哈尔161000

出　　处：《哈尔滨医科大学学报》2013年第6期532-536,共5页Journal of Harbin Medical University

摘　　要：目的比较单纯全麻和高位胸段硬膜外阻滞复合全麻对非体外循环冠脉搭桥手术患者术中循环稳定性、术后拔管时间和术后镇痛的影响。方眭选择择期非体外循环冠脉搭桥手术的冠心病患者40例，随机分为两组，高位胸段硬膜外阻滞复合全麻组（GA＋HTEA组）和单纯全麻组（GA组）。GA＋HTEA组，手术前-天于T2～L间隙置人硬膜外导管，确定麻醉平面在T1-T4后诱导插管，术中吸入异氟烷和硬膜外泵人0．33％罗派卡因＋1．33％利多卡因维持麻醉。GA组，常规诱导插管，术中吸人异氟烷维持麻醉。两组术中分别于进人手术室后5min、诱导后3min、插管后3min、切皮即刻、劈胸骨即刻和手术结束记录患者的血压、心率和血氧饱和度。比较两组患者的术后拔管时间及拔管即刻，拔管后6h，12h，24h的疼痛评分。结果GA＋HTEA组与GA组比较术中血压变化差异无显著性，但在诱导、插管和手术结束时心率明显降低；GA＋HTEA组患者术后拔管时间明显短于GA组；GA＋HTEA组术后镇痛效果明显好于GA组。结论高位胸段硬膜外阻滞复合全麻相对于单纯全麻，对非体外循环冠脉搭桥手术患者的循环影响不明显，拔管时间明显缩短，术后镇痛效果好。Objective To compare general anesthesia with combined general anesthesia plus high thoracic epidural anesthesia in patients scheduled for off-pump coronary artery bypass grafting （OPCABG） surgery on the circulation stability, postoperative extubation time and post- operative analgesia. Methods Forty consenting patients undergoing off-pump coronary artery revascularization randomly assigned to two groups （ group HTEA ＋ GA and group GA）. In the HTEA ＋ GA group patients underwent epidural catheterization the day before surgery. We did not begin inducing general anesthesia until defining the block over T1 - T4. Patients were maintained by isoflurane and epidural anesthesia （ropivacaine 0. 33% ＋ 1.33% lidocaine）. In the GA group patients received general anesthesia alone. Hemodynamic measurements were recorded 5 rain after getting in the operating room, 3 rain after induction, 3 rain after intubation, immediately after cutting skin, immediately after posternotomy and immediately after the end of surgery. Measurements consisted of mean artery pressure and heart rate and central venous pressure. Extubation time and postoperative pain score immediately after the extubation and at 6 hours, 12 hours and 24 hours after surgery were recorded. Results Hemodynamics was more stable in HTEA ＋ GA group than that in GA group; In the HTEA ＋ GA group patients were extubated earlier and patients＇ postoperative analgesia was substantially improved. Conclusion HTEA ＋ GA appears to be more comprehensive, providing good hemodynamic stability, allowing early extubation and reliable postoperative analgesia.

关 键 词：非体外循环冠脉搭桥手术 椎管内麻醉 硬膜外麻醉 

分 类 号：R614.2[医药卫生—麻醉学] R654.2[医药卫生—外科学]